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WO1992019144A2 - Dispositif et methode d'agrafage endoscopique - Google Patents

Dispositif et methode d'agrafage endoscopique Download PDF

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Publication number
WO1992019144A2
WO1992019144A2 PCT/US1992/003589 US9203589W WO9219144A2 WO 1992019144 A2 WO1992019144 A2 WO 1992019144A2 US 9203589 W US9203589 W US 9203589W WO 9219144 A2 WO9219144 A2 WO 9219144A2
Authority
WO
WIPO (PCT)
Prior art keywords
staple
jaws
closed
leg
configuration
Prior art date
Application number
PCT/US1992/003589
Other languages
English (en)
Other versions
WO1992019144A3 (fr
Inventor
Naomi Nakao
Peter J. Wilk
Original Assignee
Naomi Nakao
Wilk Peter J
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Naomi Nakao, Wilk Peter J filed Critical Naomi Nakao
Publication of WO1992019144A2 publication Critical patent/WO1992019144A2/fr
Publication of WO1992019144A3 publication Critical patent/WO1992019144A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/10—Surgical instruments, devices or methods for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A61B17/083—Clips, e.g. resilient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/128—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A61B17/1222—Packages or dispensers therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00535—Surgical instruments, devices or methods pneumatically or hydraulically operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00535—Surgical instruments, devices or methods pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods pneumatically or hydraulically operated hydraulically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00535—Surgical instruments, devices or methods pneumatically or hydraulically operated
    • A61B2017/00544—Surgical instruments, devices or methods pneumatically or hydraulically operated pneumatically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible

Definitions

  • This invention relates to an endoscopic or laparo- scopic stapling device. More particularly, this invention relates to a device usable with an endoscope and/or in a _, ⁇ ? laparoscopic surgical procedure for performing a stapling operation on a patient's internal body tissues at a surgical site not visible to the unaided eye. This invention also relates to a surgical procedure utilizing an endoscope or laparoscope. The invention also involves a surgical staple, an associated staple holder or package and a magazine for holding a plurality of staples.
  • An object of the present invention is to provide a surgical procedure for closing openings internal to a patient's body, which is less invasive than conventional surgical closure methods.
  • Another object of the present invention is to pro ⁇ vide such a surgical procedure which is quicker than conven ⁇ tional surgical proceures and which reduces the typical postoperative convalescence period.
  • a related object of the present invention is to pro ⁇ vide an improved surgical closure procedure using an endoscope or laparoscope.
  • Another object of the present invention is to pro ⁇ vide a stapling device usable with an endoscope or in a laparoscopic sugical procedure.
  • An associated object of the present invention is to provide an endoscopic or laparoscopic stapling device.
  • Another, more particular, object of the present invention is to provide a staple usable with such an endo- scopic or laparoscopic stapling device.
  • a further particular object of the present invention is to provide a staple package for use with such an endoscopic stapling device.
  • a staple having a spring bias tending to force the staple into an opened configuration.
  • the staple has a pair of legs con ⁇ nected to one another by a bight portion and further has an additional spring bias or a pair of locking elements for main ⁇ taining the staple in a closed postfiring configuration.
  • the method in accordance with the present invention comprises the steps of (a) exerting a closure force on the staple to hold the staple in a closed prefiring configuration inside the dis ⁇ tal end of a surgical instrument in opposition to the spring bias, (b) shifting the staple in a distal direction to eject the staple from the surgical instrument, (c) relaxing the closure force, thereby permitting the staple to open under the spring bias, (d) inserting distal ends of the legs into the internal body tissues to be stapled, and (e) closing the staple and maintaining the staple in the closed postfiring configuration.
  • a tubular endoscopic member is inserted through an aperture in the patient's body and is used to visually locate the internal body tissues inside the patient's body.
  • an elongate for ⁇ ceps member is pushed in a distal direction through a biopsy channel in the endoscopic member to eject a staple stored in a closed configuration between jaws of the forceps member inside the channel at a distal end of the endoscopic member.
  • the jaws are opened and the staple concomitantly opened from the closed configura ⁇ tion to an opened configuration.
  • the forceps member is then pushed further in the distal direction to move the opened staple and the jaws towards the internal body tissues.
  • the forceps jaws are subsequently closed to grip the internal body tissues and to close the staple in the body tissues.
  • the staple is maintained in a closed postfiring configuration in the internal body tissues, for example, through the coopera ⁇ tion of interlocking elements on the staple legs.
  • the forceps member are opened to release the internal body tissues and the forceps member is retracted into the biopsy channel of the endoscopic member. Upon such retraction, the tubular endoscopic member is with ⁇ drawn out of the patient's body though the aperture.
  • the aperture through which the endoscopic instrument is inserted may be a natural body opening or, alternatively, an opening formed by piercing the patient's body, for example, with a trocar.
  • Yet another method for performing a surgical opera ⁇ tion on internal body tissues of a patient comprises, in accordance with the present invention, the steps of (i) inserting a tubular endoscopic member through an aperture in the patient's body, (ii) using the endoscopic member to visually locate the internal body tissues inside the patient's body, and (iii) upon locating the surgical site, pushing an elongate ejector member in a distal direction through a biopsy channel in the tubular endoscopic member to eject a staple stored in a closed configuration inside the channel at a dis ⁇ tal end of the tubular endoscope member.
  • the staple Upon ejection of the staple from the channel, the staple is opened from the closed configuration to an opened configuration and is pushed towards the internal body tissues to be joined.
  • the staple Upon contact of the opened staple with the internal body tissues, the staple is closed about a portion of the internal body tissues.
  • the tubular endoscopic member is with ⁇ drawn out of the patient's body though the aperture.
  • the step of pushing the opened staple comprises the step of pushing the elongate ejector member further in the distal direction.
  • the step of closing comprises the step of pushing an elongate inner tubular member, disposed in the channel about the ejector member, in the distal direction to engage legs of the staple and thereby collapse the legs towards one another.
  • the staple is spring biased towards an opened configuration, the step of opening being accomplished automatically by internal forces in the staple upon ejection of the staple from the channel.
  • a surgical instrument comprises, in accordance with the present invention, an elongate outer tubular member and a biopsy channel extending longitudinally through the tubular member, and an elongate forceps member slidably disposed in the biopsy channel, the forceps member being provided at a distal end with a pair of forceps jaws each formed on an inwardly facing surface with a longitudinally extending groove.
  • An actuator is provided for manipulating the jaws between an opened and a closed position.
  • a staple having a spring bias tending to force the staple into an opened con ⁇ figuration is disposed in a closed prefiring configuration between the jaws when the jaws are closed.
  • the staple has legs each disposed in the closed prefiring configuration in a respective one of the grooves.
  • the staple further has closure means for maintaining the staple in a closed postfiring con ⁇ figuration.
  • the staple has a pair of legs joined by a bight portion, the closure means including a pair of interlocking elements on the legs.
  • the interlocking elements are disposed proximately to the bight portion or, alternatively, at the distel ends of the legs.
  • a surgical instrument utilizable with an endoscope or a rigid tubular member for performing an endoscopic or laparoscopic stapling operation comprises, in accordance with the present invention, an elongate forceps member having a diameter sufficiently small so that the forceps member is slidably insertable into a biopsy channel extending longi ⁇ tudinally through an outer tubular member, the forceps member being provided at a distal end with a pair of forceps jaws each formed on an inwardly facing surface with a longi ⁇ tudinally extending groove.
  • An actuator is provided for manipulating the jaws between an opened position and a closed position.
  • a first staple having a spring bias tending to force the staple into an opened configuration is disposed in a closed prefiring configuration between the jaws when the jaws are closed.
  • the staple has legs each disposed in the closed prefiring configuration in a respective one of the grooves and further has closure means for maintaining the staple in a closed postfiring configuration upon a closing of the forceps jaws.
  • a staple holder is maintained in a predetermined posi ⁇ tion relative to the forceps jaws and contains a plurality of second staples disposed end to end to form a staple magazine.
  • Each of the second staples has a spring bias tending to force the respective second staple into an opened configuration and is disposed in a closed prefiring configuration in the holder.
  • a mechanism is provided for advancing the second staples in a distal direction towards the jaws upon a firing of the first staple.
  • the instrument includes a mechanism for preventing an advance of the second staples in the distal direction while the forceps jaws are opened.
  • that mechanism includes a part on at least one of the jaws which engages a most distal of the second staples upon an opening of the jaws.
  • a surgical device utilizable with an endoscope or rigid tubular member for performing an endoscopic or laparo ⁇ scopic stapling operation comprises, in accordance with a broadened conceptualization of the present invention, a first staple having a spring bias tending to force the staple into an opened configuration, a first holder for temporarily main ⁇ taining the first staple in a closed prefiring configuration at a distal end of an elongate surgical instrument, and an ejector for ejecting the first staple from the distal end of the instrument.
  • An actuator is operatively connected to the ejector for actuating the ejector.
  • a plurality of second staples each having a spring bias tending to force the respec ⁇ tive second staple into an opened configuration are contained in a magazine holder in the instrument.
  • the second staples are disposed end to end in a closed prefiring configuration in the magazine and in a substantially linear array having a predetermined position relative to the first holder.
  • a mechanism is provided for advancing the second staples towards the distal end of the instrument upon a firing of the first staple.
  • a surgical staple comprises, in accordance with the present invention, a first leg provided with a first locking element, a second leg provided with a second locking element, and a bight portion joining the first leg and the second leg to one another. At least one of the first leg, the second leg and the bight portion is provided with a spring bias tending to force the first leg and the second leg apart from one another to open the staple.
  • the first locking element and the second locking element are adapted to cooperate with one another to maintain the staple in a closed postfiring con ⁇ figuration.
  • the staple is disposed in a closed prefiring con ⁇ figuration wherein at least one of the first leg, the second leg, the bight portion, the first locking element and the sec ⁇ ond locking element is deformed to prevent cooperation of the first locking element and the second locking element.
  • the first locking element and the second locking element are disposed proximately to the bight portion.
  • the staple includes a block such as a web for at least inhibiting biological tis ⁇ sue from interfering in the cooperation of the first locking element and the second locking element.
  • a surgical staple comprises, in accordance with another embodiment of the present invention, a first leg and a second leg, and a bight portion joining the first leg and the second leg to one another, at least one of the first leg, the second leg and the bight portion being provided with a spring bias tending to force the first leg and the second leg towards one another to maintain the staple in a closed postfiring con ⁇ figuration.
  • a spring is provided for forcing the first leg and the second leg apart from one another in opposition to the spring bias, while a mechanism is provided for deactivating or destroying the spring upon a closure of the staple at a surgi ⁇ cal site.
  • a surgical staple comprises, in accordance with the present invention, a pair of legs and a bight portion joining the legs to one another, the staple being provided with an internal spring bias or a spring element tending to close the staple.
  • the staple includes rings or bores on the legs for receiving actuator elements for pulling the legs apart.
  • a surgical device utilizable with an endoscope or rigid tubular member for performing an endoscopic or laparo ⁇ scopic stapling operation comprises, in accordance with the present invention, an elongate forceps member slidably dis ⁇ posable inside a biopsy channel of an endoscopic or laparo ⁇ scopic instrument, the forceps member being provided at a dis ⁇ tal end with a pair of forceps jaws each formed on an inwardly facing surface with a longitudinally extending groove.
  • An actuator is provided for manipulating the jaws between opened and closed positions, while a staple having a spring bias tending to force the staple into a closed configuration is disposed in a closed prefiring configuration between the jaws when the jaws are closed.
  • the staple has legs each disposed in the closed prefiring configuration in a respective one of the forceps grooves.
  • a locking mechanism is pro ⁇ vided for temporarily locking the legs to the jaws during an opening motion of the jaws.
  • the locking mechanism preferably includes longi ⁇ tudinally slidable rods.
  • the rods traverse aperture forming elements such as rings or tubes on the legs.
  • Fig. 1 is a partial perspective view, taken from the side, of an endoscopic stapling device in accordance with the present invention, showing the device in a prefiring con ⁇ figuration without a loaded staple.
  • Fig. 2 is a partial perspective view, similar to Fig. 1, showing the endoscopic stapling device in the prefir ⁇ ing configuration with a loaded staple in a closed configura ⁇ tion.
  • Fig. 3 is a partial perspective view, taken from the side, of the endoscopic stapling device of Figs. 1 and 2, showing the device in an initial firing stage with an opened staple.
  • Figs. 4A-4I are partially schematic, partial per- spective views, taken from the side and on a reduced scale, of an endoscopic stapling device in accordance with the present invention, showing successive stages in the application of a surgical staple to internal body tissues.
  • Fig. 5 is a side elevational view, on an enlarged scale, of a staple for use in an endoscopic stapling device in accordance with the present invention, showing the staple in a prefiring closed configuration.
  • Fig. 6 is a side elevational view of the staple of Fig. 5, showing the staple in a closed, postfiring configura ⁇ tion.
  • Figs. 7A-7F are partially schematic, partial per ⁇ spective views, taken from the side and on a reduced scale, of an endoscopic stapling device in accordance with the present invention, showing successive steps in the application of the surgical staple of Figs. 5 and 6 to internal body tissues.
  • Figs. 8A-8F are partially schematic, partial per ⁇ spective views, similar to Figs. 8A-8F, of another endoscopic stapling device in accordance with the present invention, showing successive stages in the application of the surgical staple of Figs. 5 and 6 to internal body tissues.
  • Fig. 9 is a side elevational view of another staple usable in an endoscopic stapling device in accordance with the present invention, showing the staple in an opened configura ⁇ tion.
  • Fig. 10 is a side elevational view of the staple of Fig. 9 in a closed, postfiring configuration.
  • Fig. 11 is a side elevational view of the staple of Figs. 9 and 10, showing the staple in a closed, prefiring con ⁇ figuration.
  • Fig. 12 is a rear perspective view of the staple of Figs. 9-11, showing the staple in the closed, prefiring con ⁇ figuration.
  • Fig. 13 is an isometric view of a staple package in accordance with the present invention.
  • Figs. 14 and 15 are essentially isometric views of a staple in the package of Fig. 13, showing successive steps in the removal of the staple from the package and the simultaneous loading of the staple into an endoscopic stapling device in accordance with the present invention.
  • Fig. 16 is a partial longitudinal cross-sectional view of another endoscopic stapling device in accordance with the present invention, showing a forceps member and a staple in a closed prefiring configuration between jaws of the for ⁇ ceps member.
  • Fig. 17 is a partial longitudinal cross-sectional view of the endoscopic stapling device of Fig. 16, showing the forceps member in an extended position relative to a tubular sheath.
  • Fig. 18 is a partial longitudinal cross-sectional view of the endoscopic stapling device of Figs. 16 and 17, showing the forceps member and the staple in an opened con ⁇ figuration.
  • Fig. 19 is a top view of the forceps member of Figs. 16, 17 and 18.
  • Figs. 20A through 20D are schematic partial side elevation views showing successive steps in the operation of an endoscopic stapling device like the device of Figs. 16-19.
  • Figs. 21A through 2ID are schematic partial side elevation views showing successive steps in the operation of another endoscopic stapling device like the device of Figs. 16-19.
  • Fig. 22 is a block diagram of yet another endoscopic stapling device in accordance with the present invention.
  • Figs. 23A-23C are schematic diagrams showing successive ⁇ sive stages in the operation of an endoscopic or laparoscopic staple applicator with a staple magazine, in accordance with the present invention.
  • Figs. 24A-24C are schematic diagrams showing successive ⁇ sive stages in the operation of another endoscopic or laparo ⁇ scopic staple applicator with a staple magazine, in accordance with the present invention.
  • Fig. 25 is a partial longitudinal cross-sectional view, on an enlarged scale, of a distal end of yet another endoscopic or laparoscopic staple applicator with a staple magazine, in accordance with the present invention.
  • Fig. 26 is a partial longitudinal cross-sectional view, on a larger scale, of an intermediate portion of the endoscopic or laparoscopic staple applicator of Fig. 25.
  • Fig. 27 is a side elevational view of a staple for use with the endoscopic or laparoscopic applicators of Figs. 23A-23C, 24A-24C, and 25-26.
  • Figs. 28A and 28B are side perspective views of a further staple or clip in accordance with the present inven ⁇ tion, showing the staple in a closed prefiring and a closed postfiring configuration, respectively.
  • Figs. 29A and 29B are side perspective views of an additional staple or clip in accordance with the present invention, showing the staple in a closed prefiring and a closed postfiring configuration, respectively.
  • Figs. 30A and 3OB are side perspective views of another staple or clip in accordance with the present inven ⁇ tion, showing the staple in a closed prefiring and a closed postfiring configuration, respectively.
  • Figs. 31A and 3IB are side perspective views of yet another staple or clip in accordance with the present inven ⁇ tion, showing the staple in a closed prefiring and a closed postfiring configuration, respectively.
  • Figs. 31A, 31B and 31C are side perspective views of yet another staple or clip in accordance with the present invention, showing the staple in a closed prefiring, a first closed postfiring configuration and a second closed postfiring configuration, respectively.
  • Figs. 32A, 32B and 32C are side elevational views of a staple in accordance with the present invention, showing the staple in a closed prefiring, an opened and a closed postfir ⁇ ing configuration, respectively.
  • Figs. 33A, 33B and 33C are side perspective views of another staple or clip in accordance with the present inven ⁇ tion, showing the staple in a closed prefiring, an opened and a closed postfiring configuration, respectively.
  • Fig. 35 is a side elevational view of the staple or clip of Figs. 33A-33C, showing the staple in a closed postfir ⁇ ing configuration about a piece of body tissue.
  • Figs. 36A and 36B are side perspective views of another staple or clip in accordance with the present inven ⁇ tion, showing the staple in a closed prefiring and an opened configuration, respectively.
  • Fig. 36C is a side elevational view of the staple or clip of Figs 36A and 36B, in a closed postfiring configura ⁇ tion.
  • Fig. 37 is a side elevational view of yet another staple or clip, in a closed postfiring configuration.
  • Fig. 38 is a side and front perspective view of another surgical staple for use in endoscopic applications, in accordance with the present invention.
  • Fig. 39 is a longitudinal cross-sectional view of forceps jaws for applying the staple of Fig. 38 in an endo ⁇ scopic or laparoscopic surgical operation. '
  • Fig. 40 is a longitudinal cross-sectional view of the staple of Fig. 38 seated in the forceps jaws of Fig. 39, with locking rods in place for entraining the staple to the forceps jaws.
  • Fig. 41 is a side and front cross-sectional view of another surgical staple, in accordance with the present inven ⁇ tion.
  • Fig. 42 is a front elevational view of the staple of Fig. 41.
  • Fig. 43 is a rear elevational view of the staple of Figs. 41 and 42. Detailed Description
  • an endoscopic sta ⁇ pling device 20 comprises an outer elongate flexible tubular member 22 having a diameter sufficiently small so that the tubular member is slidably insertable into a biopsy channel 24 extending longitudinally through a flexible tubular endoscope member 26.
  • Endoscopic stapling device 20 further comprises an inner elongate flexible tubular member 28 slidably disposed inside tubular member 22 and an elongate flexible rod member 30 slidably disposed inside inner tubular member 28.
  • a staple 32 is disposed in a closed configuration at least partially inside inner tubular member 28 distally of a distal end of rod member 30.
  • Outer tubular member 22 is provided at a distal end with a forceps 34 including a pair of spring loaded jaws 34a and 34b.
  • staple 32 includes a pair of legs 32a and 32b seated in the prefiring configuration of the endoscopic stapling device 20 in grooves 36a and 36b pro ⁇ vided on inwardly facing surfaces of forceps jaws 34a and 34b.
  • jaws 34a and 34b serve to open staple 32 upon an ejection thereof from inner tubular member 28 by a distally directed motion of rod member 30.
  • Jaws 34a and 34b are releasably connected to staple legs 32a and 32b so that staple 32 becomes detached from forceps 34 upon the attainment of a predetermined angular displacement between jaws 34a and 34b. More particularly, the free ends of staple legs 32a and 32b are held in the prefiring configuration of the endoscopic stapling device in cup-shaped recesses 38 formed at the free ends of jaws 34a and 34b.
  • Staple 32 further includes a bight portion 32c join ⁇ ing staple legs 32a and 32b to one another and to a planar projection 32d extending away from bight portion 32c in a direction opposite legs 32a and 32b.
  • projection 32d is received in a cross-sectionally rectangular recess or opening 39 at the dis ⁇ tal end of rod member 30.
  • projection 32d and recess 39 may have any of several different geometric shapes. In par ⁇ ticular, other polygonal cross-sections can be used.
  • endoscopic stapling device 20 includes an assembly 40 at its proximal end for ena ⁇ bling the operation of the device by a surgeon during an operation.
  • Assembly 40 includes a housing or casing member 42 mountable to endoscope 26 at a proximal end thereof.
  • Project ⁇ ing from casing 42 are a plurality of handles or knobs 44, 46 and 48 which are mechanically connected to outer tubular mem ⁇ ber 22, rod member 30 and inner tubular member 28, respec ⁇ tively, for enabling the sliding of those members along biopsy channel 24 by a surgeon or other authorized operator.
  • Figs. 4A through 41 show the positions of handles 44, 46 and 48 cor ⁇ responding to the operative configurations of outer tubular member 22, rod member 30, inner tubular member 28, and staple 32 shown in the respective drawing figures.
  • Figs. 4A and 4B are similar to Figs. 2 and 3.
  • Fig. 4A shows endoscopic stapling device 20 in a prefiring con- figuration in which outer tubular member 22, inner tubular member 28, rod 30 and staple 32 are all located in biopsy channel 24 of endoscope 26. More specifically, staple 32 is disposed in a closed prefiring configuration distally of rod member 30 and inside tubular member 28 at the distal end thereof.
  • Endoscope 26 has already been inserted through an aperture (not illustrated) in a patient's body (not shown) and has been used to visually locate in the patient's body the internal body tissues upon which a stapling operation is to be performed.
  • the internal body tissues may be a vessel or duct which needs to be closed or perhaps an opening in the stomach wall.
  • tubular outer member 22 and rod member 30 are pushed in the distal direction through biopsy channel 24 to eject staple 32 from tubular member 28.
  • jaws 34a and 34b pivot away from one another and pull apart staple legs 32a and 32b, as shown in Fig. 4B.
  • the free ends of legs 32a and 32b slip out from recesses 38 at the distal ends of grooves 36a and 36b.
  • Staple 32 is now in a released, opened configuration, as depicted in Fig. 4C.
  • rod member 30 is pushed further in the distal direction to move opened staple 32 towards internal body tissues 50 having an opening 52 previously detected through the optical pathway (not illustrated) of endoscope 26.
  • Fig. 4D shows staple 32 substantially embedded in the body tissues 50 in a region about opening 52.
  • inner tubular member 28 Upon the embedding of opened staple 32 in internal body tissues 50, inner tubular member 28 is pushed in the dis ⁇ tal direction to engage staple legs 32a and 32b and thereby close the staple about opening 52. The distal motion of inner tubular member 28 relative to rod member 30 and staple 32 bends legs 32a and 32b about bight portion 32c, causing staple 32 to assume a closed, tissue-clamping configuration shown in Fig. 4E.
  • inner tubular member 28 is retracted into biopsy channel 24.
  • rod member 30 may be moved even fur ⁇ ther in the distal direction to push staple 32 further into tissues 50. This step serves to limit the extent that the staple projects from tissues 50.
  • outer tubular member 22, inner tubular member 28 and rod member 30 are all disposed in biopsy channel 24, so that the distal ends of those members do not extend beyond the distal end of the channel.
  • the entire endoscopic instrument is then withdrawn from the patient's body through the aperture through which it was introduced.
  • That aperture may take the form of a natural body opening.
  • the endoscope introduction aperture may be formed through the use of a trocar. Such a procedure can be followed, for example, to repair a hernia through a small opening in the abdominal wall.
  • a staple 54 for an endoscopic stapling device in accordance with the present invention includes a pair of legs 54a and 54b joined by a bight section 54c and provided on a side of the bight section opposite the legs with a projection 54d terminating in a knob or ball 56.
  • Each leg 54a and 54b is provided at a free end with a respective inwardly turned foot 58a and 58b.
  • legs 54a and 54b are provided towards the proximal end of the staple with inter ⁇ locking finger elements 60a and 60b having barbs or hooks 62a and 62b which cooperate with one another to lock the staple in a closed configuration at the end of a stapling operation.
  • Staple 54 is spring biased, by virture of the inherent structural characteristics of its preferably metallic material, towards an opened (legs spread) configuration.
  • the material and dimensions of staple 54 are selected so that the staple is sufficiently flexible to be temporarily distorted into the prefiring configuration shown in Fig. 5.
  • legs 54a and 54b are longitudinally shifted relative to one another and interlocking finger elements 60a and 60b releasably engage each other along planar faces 64a and 64b.
  • staple 54 is disposed in its prefiring configuration inside the distal end of an elongate flexible tubular member 66 distally of an elongate flexible rod member 68 itself slidably inserted in tubular member 66.
  • Staple 54 is releasably attached to rod member 68 by a ball and socket connection comprising knob 56 and a cor ⁇ responding recess 70 at the distal end of rod 68.
  • Tubular member 66 has a diameter sufficiently small so that it is slidably insertable into a biopsy channel 72 extending longitudinally through a flexible tubular endoscope member 74.
  • rod member 68 is shifted in a distal direction to eject staple 54 from tubular member 66.
  • the ejected staple automatically assumes an opened configuration illustrated in Fig. 7B. Further distally directed motion of rod member 68 pushes the opened staple 54 into the internal body tissues 76 of the patient, as shown in Fig. 7C.
  • tubular member 66 Upon an embedding of staple 54 in body tissues 76 about a cut, tear or other opening 78, tubular member 66 is shifted distally from the endoscope and engages staple legs 54a and 54b to bend them inwardly towards one another in oppo ⁇ sition to the internal spring forces of the staple. Upon a sufficient advance of tubular member 66, barbs or hooks 62a and 2b of finger elements 60a and 60b interlock and hold staple legs 54a and 54b in the closed configuration (Fig. 7D) . Tubular member 66 is then withdrawn back into the biopsy chan ⁇ nel of the endoscope (Fig. 7E) . Finally, as depicted in Fig.
  • rod member 68 is retracted and the endoscope removed from the patient's body.
  • rod member 68 is retracted prior to the withdrawal of tubular member 66.
  • tubular member 66 serves to hold staple 54 against the return stroke of rod member 68 and facilitates the removal of knob 56 from recess 70.
  • the forces holding the ball and socket joint together are smaller than the forces retaining staple 54 in body tissues 76 so that there will be no problem retracting rod member 68 subsequently to the withdrawal of tubular member 66.
  • another endoscopic stapling device 80 similar to the device of Figs. 7A-7F includes an outer elongate flexible tubular member 82 having a diameter sufficiently small so that the tubular member is slidably insertable into a biopsy channel 84 extending longi ⁇ tudinally through a flexible tubular endoscope member 86.
  • Endoscopic stapling device 80 further comprises an inner elongate flexible tubular member 88 slidably disposed inside tubular member 82 and an elongate flexible rod member 90 slidably disposed inside inner tubular member 88.
  • Fig. 8A-8F another endoscopic stapling device 80 similar to the device of Figs. 7A-7F includes an outer elongate flexible tubular member 82 having a diameter sufficiently small so that the tubular member is slidably insertable into a biopsy channel 84 extending longi ⁇ tudinally through a flexible tubular endoscope member 86.
  • Endoscopic stapling device 80 further comprises an inner elong
  • a staple 91 (similar to staple 54) is disposed in a closed configuration at least par ⁇ tially inside inner tubular member 88 distally of a distal end of rod member 90.
  • Staple 91 is releasably attached to rod member 90 by a ball and socket connection comprising a knob ⁇ like projection 92 on the staple and a corresponding recess 93 at the distal end of rod 90.
  • Outer tubular member 82 is provided at a distal end with a forceps 94 including a pair of metal jaws 94a and 94b which are spring biased towards a spread-apart state by virtue of their own internal microstructure.
  • Fig. 8A shows endoscopic stapling device 80 in a prefiring configuration in which outer tubular member 82 including forceps jaws 94a and 94b, inner tubular member 88, rod 90 and staple 91 are all located in biopsy channel 84 of endoscope 86. More specifically, staple 91 is disposed in a closed prefiring configuration (see Fig. 5) distally of rod member 30 and inside tubular member 28 at the distal end thereof. Endoscope 86 is inserted through an aperture (not illustrated) in a patient's body (not shown) and is used to visually locate in the patient's body the internal body tis ⁇ sues upon which a stapling operation is to be performed.
  • tubular outer member 82 and rod member 90 are pushed in the distal direction through biopsy channel 84 to open forceps jaws 94a and 94b and to eject staple 91 from tubular member 88, as depicted in Fig. 8B.
  • outer tubular member 82 and rod member 90 are pushed further in the distal direction to move opened staple 91 towards internal body tissues 100 having an opening 102 previously detected through the optical pathway (not illustrated) of endoscope 86.
  • Fig. 4C shows forceps jaws 94a and 94b and staple 91 substantially embedded in the body tissues 100 in a region about opening 102.
  • inner tubular member 88 Upon the embedding of opened staple 91 in internal body tissues 100, inner tubular member 88 is pushed in the distal direction to engage staple legs 91a and 91b and thereby close the staple about opening 102. Simultaneously, as illustrated in Fig. 8D, an additional outer tubular member 96 slidably disposed in biopsy channel 84 around tubular member 82 is shifted distally to engage forceps jaws 94a and 94b and thereby close the forceps 94 to aid in the closure of opening 102 during the stapling operation.
  • outermost tubular member 96 and inner tubular member 88 are retracted into biopsy channel 84.
  • tubular member 82 is moved proximally to withdraw forceps 94 from body tissues 100.
  • forceps jaws 94a and 94b pivot towards one another through a camming action when the jaws slide past the rim or lip at the distal end of biopsy channel 84 or past the mouth of outermost tubular member 96.
  • rod member 90 is retracted into inner tubular member 88 (Fig.
  • FIG. 9-12 Another staple 104 usable in an endoscopic stapling device in accordance with the present invention is illustrated in Figs. 9-12.
  • That staple includes includes a pair of legs 104a and 104b joined by a bight section 104c and provided on a side of the bight section opposite the legs with a projection 104d terminating in a knob or ball 106.
  • Each leg 104a and 104b is provided at a free end with a respective inwardly turned foot 108a and 108b.
  • Foot 108a is formed on an outer, distally facing side with a barb or hook 110a, while foot 108b is provided on an inwardly or proximally facing face with another barb or hook 110b.
  • hooks 110a and 110b interfit and thereby cooperate with one another to lock the staple in a closed configuration at the end of a stapling operation.
  • legs 104a and 104b of staple 104 are spring biased outwardly. Thus, a force pressing legs 104a and 104b towards one another is required to close staple 104.
  • Figs. 11 and 12 show staple 104 in the prefiring closed configuration.
  • the staple legs 104a and 104b are dis ⁇ posed side-by-side.
  • legs 104a and 104b spring apart under the action of internal forces (Fig. 9) so that hooks 110a and 110b are aligned with one another.
  • the staple of Figs. 9-12 is particularly useful in closing tubular body organs such as blood vessels, sperm ducts, and Fallopian tubes.
  • a surgical staple package 112 comprises a container 114 provided with a plurality of cylindrical recesses 116 having a common diameter dl. Dis ⁇ posed in each recess 116 is a respective annular sleeve 118. Sleeves 118 have a common outside diameter d2 smaller than diameter dl of recesses 116, whereby an annular space 120 is formed between each sleeve 118 and the cylindrical wall defin ⁇ ing the respective recess 116.
  • a plurality of staples 122 are seated in sleeves 118, each staple 122 being provided with a connector element 124 in the form of a knob, a plate or other cross-sectionally polygonal member for releasably connecting the respective staple to the distal end of a flexible rod mem- ber 30, 68, 90 of an endoscopic stapling device.
  • Staples 122 whether in the specific form of staple 32, 54, or 104 or some other form consistent with the principles of the invention, are placed in a prefiring closed configuration in sleeves 118.
  • Annular spaces 120 have a width and a diameter suf ⁇ ficiently large so that the annular spaces can each receive the distal end of an inner tubular member 28, 66, 88 of an endoscopic stapling device. As illustrated in Figs. 14 and 15 to load a staple 122 from package 112, the distal end of a flexible tubular member 126 of an endoscopic stapling device in accordance with the invention is inserted into the annular space 120 about the respective staple.
  • a flexi ⁇ ble rod member 128 of the endoscopic stapling device is moved distally through tubular member 126 until a recess 130 at the distal end of rod member 128 receives connector element 124, releasably securing the staple 122 to rod member 128.
  • Tubular member 126 is then withdrawn from the annular space 120 and the staple 122 removed from its respective sleeve 118. The entire endoscopic stapling device is then inserted into the biopsy channel of an endoscope.
  • an endoscopic stapling device in accordance with the invention may be removed from the endoscope's biopsy channel and reloaded with another staple while the endoscope remains partially inserted in the patient's body.
  • another endoscopic sta ⁇ pling device comprises an elongate flexible outer tubular mem ⁇ ber 140 having a diameter sufficiently small so that the tubular member is slidably insertable into a biopsy channel extending longitudinally through a flexible tubular endoscope.
  • Slidably inserted inside tubular member 140 is an elongate flexible rod member 142 provided at a distal end with an actuator plate 144 formed at a distal end with a pair of sub ⁇ stantially colinear camming apertures or slots 146 and 148.
  • Slots 146 and 148 are traversed by respective pins 150 and 152 connected to respective fingers or levers 154 and 156 of a pair of forceps jaws 158 and 160.
  • Tubular member 140, rod member 142, actuator plate 144, fingers 154 and 156, and jaws 158 and 160 form parts of an elongate flexible forceps member 161 slidably insertable through the biopsy channel of an endo ⁇ scope for performing stapling operations on internal body tis ⁇ sues of a patient without the necessity of opening the patient's body by means of an extensive incision.
  • Fingers or levers 154 and 156 are pivotably con ⁇ nected to one another by an elongate transversely oriented pin
  • slots 164 serve to limit the motion of jaws 158 and 160 with respect to tubular member 140 and to guide the jaws in longitudinal shifts along tubular member 140.
  • Jaws 158 and 160 are formed on inwardly facing sur ⁇ faces with respective longitudinal grooves 166 and 168 in which legs 170 and 172 of a staple 174 are seated.
  • Staple 174 has a spring bias construction tending to force the staple into an opened configuration.
  • the staple is maintained between jaws 158 and 160 in a closed prefiring configuration through its seating in grooves 166 and 168.
  • Distal ends of jaws 158 and 160 are formed with teeth 173 and 175 for gripping or grasping internal body tis ⁇ sues at a surgical site, to pull the tissues together and to maintain them in a bunched state during a stapling operation.
  • Legs 170 and 172 of staple 174 are provided on inwardly facing sides with a pair of locking elements 176 and 178 formed on distal and proximal sides with respective hooks 180 and 182 and having smooth surfaces 184 and 186 on the opposing sides.
  • smooth surfaces 184 and 186 engage one another and assist in retaining staple 174 in a deformed state.
  • rod member 142 is pushed in a distal direction through tubular member 140, thereby sliding pin 162 along slots 164 until pin 164 contacts the distal ends of the slots.
  • jaws 158 and 160 have attained their most distal position with respect to tubular member 140.
  • Continued motion of rod member 142 in the distal direction pivots fingers or levers 154 and 156 about pin 162, which remains fixed at the distal end of slots 164, in opposition to a restoring torque exerted on fingers or levers 154 and 156 by a tension spring 188.
  • the pivoting of fingers or levers 154 and 156 also pivots jaws 158 and 160 from the closed configuration of Figs. 16 and 17 to the opened configuration of Fig. 18.
  • jaws 158 and 160 allows staple 174 to open under its own internal biasing forces from the closed prefiring configuration of Figs. 16 and 17 to an opened firing-ready configuration of Fig. 18.
  • legs 170 and 172 of staple 174 shift relative to one another upon an opening of the staple so that locking elements 176 and 178 can lock upon a closing of staple 174 under the pressure exerted by jaws 158 and 160 during a closing thereof.
  • Jaws 158 and 160 are closed by pushing tubular member 140 in the distal direction while maintaining the position of jaws 158 and 160 with respect to an internal surgical site.
  • a stapling operation commences with inserting a tubular endoscope member 190 through an aperture (not illustrated) in a patient's body (not illustrated) .
  • the endoscope is used to visually locate inter ⁇ nal body tissues 192 inside the patient's body which require a surgical operation.
  • a surgeon pushes an elongate flexible forceps member 194 in a distal direction through a biopsy channel 196 in tubular endo ⁇ scope member 190.
  • the shifting of forceps member 194 results in an ejection from biopsy channel 196 of a staple 198 stored in a closed configuration between jaws 200 and 202 of forceps member 194 inside the biopsy channel at a distal end thereof.
  • Forceps member 194 may take the form of forceps 161 or any similar forceps wherein a staple having an open bias is seated between forceps jaws, preferably but not necessarily in grooves provided in the jaws.
  • Staple 198 preferably takes the form of staple 174 and has locking hook elements 204 and 206 for locking the staple in a closed configuration upon disposi ⁇ tion thereof in body tissues 192 on opposite sides of a wound 208.
  • jaws 200 and 202 of forceps member 194 Upon ejection of staple 198 from channel 196, the surgeon opens jaws 200 and 202 of forceps member 194, for example, by pushing an elongate flexible rod member 142 (Figs. 16-19) .
  • the opening of jaws 200 and 202 permits staple 198 to open from a closed prefiring configuration to an opened configuration (Fig. 20B) .
  • Forceps member 194 is then pushed further in the distal direction to move the opened staple 298 and jaws 200 and 202 into internal body tissues 192, as shown in Fig. 20C.
  • the surgeon Upon contact between jaws 200 and 202 and the internal body tissues 192, the surgeon operates forceps member 194 to close the jaws, thereby grasping the internal body tis ⁇ sues between gripping teeth 210 and 212 of jaws 200 and 202 and closing staple 198 in the body tissues about wound 208.
  • the closing of staple 198 automatically locks the staple in the closed cofiguration owing to locking hook ele ⁇ ments 204 and 206.
  • the surgeon opens jaws 200 and 202 to release said internal body tissues.
  • the forceps member 194 is then retracted into the biopsy channel 196 of endoscope member 190, which is then withdrawn from the patient.
  • jaws 200 and 202 may be accomplished as described hereinabove with reference to Figs. 16-19 or by any other means suitable in the art.
  • Figs. 21A through 21D illustrate the use of an endo ⁇ scopic stapling device with forceps jaws 214 and 216 and an open-biased staple 218 to close a duct 220 in a patient's body.
  • Staple 218 is provided with locking elements 222 and 224 having distally and proximally facing hooks 226 and 228 which engage one another to lock the staple upon closure thereof about duct 220.
  • Locking elements 222 and 224 having proximally and distally facing smooth surfaces 230 and 232 which contact one another in the closed prefiring configura ⁇ tion of staple 218.
  • another endoscopic sta ⁇ pling device comprises a pneumatic or hydraulic cylinder 234 operatively connected to forceps jaws 236 via a schematically indicated plunger and linkage mechanism 238 which may be similar to actuator plate 144, slots 146 and 148, pins 150 and 152, and fingers or levers 154 and 156.
  • Cylinder 234 is fed with pressurized air or liquid from a reservoir or source 240 via a manually operable valve 242.
  • a staple 174, 198 or 218 is loadable between respec ⁇ tive forceps jaws by withdrawing the entire flexible forceps from the endoscopic member with which the forceps is being used.
  • an endoscopic or laparoscopic surgical instrument com ⁇ prises an elongate holder in the form of an elongate tubular member 244 which defines an elongate receptacle or chamber 246.
  • Receptacle 246 is substantially rectagular in transverse cross-section for receiving a plurality of identical surgical staples 248 in accordance with the invention.
  • Each staple 248 has a spring bias tending to force the staple into an opened configuration and is disposed in a closed prefiring configura ⁇ tion in the holder 244.
  • the staples are lined up end to end in holder 244 to form a linear magazine.
  • a mechanism in the form of a compressed helical spring 250 is provided at the proximal end of receptacle or chamber 246 for advancing the staples 248 in a distal direction towards a pair of forceps jaws 252 upon a firing of a most distal staple 254 which is disposed in grooves (not illustrated) in the jaws.
  • staples 248 are shown as being spaced from one another for purposes of clarity in the drawing. In actuality, staples 248 contact each other at their proximal and distal ends, whereby spring 250 is able to push the entire magazine in the distal direction to load staples 248 successive sively into jaws 252.
  • jaws 252 are schematically illustrated as being swingably attached to holder 244 at pivot points 256.
  • forceps jaws 252 are designed to block staples 248 from advancing in holder 244 upon an opening of the forceps jaws. This blocking action is implemented by the shape of jaws 252 and their mounting relative to holder 244. (See description hereinafter with reference to Fig. 24.) Forceps jaws 252 are manually actuated via one or more grips 258 at the proximal end of the instru ⁇ ment. It is to be understood that the tubular holder 244 is dimensioned for insertion into the biopsy channel of an endo- scope or laparascope.
  • foremost staple or clip 254 opens automatically under the action of its spring bias.
  • staple 254 is then closed about a wound, incision or tear 260 in internal body tissues 262, as illustrated in Fig. 23C.
  • the staples 248 in holder 244 are blocked from distally advancing because of the continued presence of foremost staple 254 inside jaws 252.
  • jaws 252 are opened and withdrawn from around the applied staple 254.
  • Figs. 24A-24C illustrate successive steps in the operation of another endoscopic or laparoscopic surgical device.
  • the device of Figs. 24A-24C has the same structure and operates in the same manner as the instrument of Figs. 23A-23C, except that the staple advance mechanism takes the form of a manually actuated push rod 264 instead of helical spring 250.
  • Push rod 264 is moved in the distal direction to advance staples 248 towards jaws 252 upon the application of staple 254 to body tissues.
  • a pair of forceps jaws 266a and 266b are pivotably connected via respective pins 268a and 268b to a tubular forceps frame 270 slidably inserted inside a biopsy channel 272 of an endoscopic instrument 274, e.g., a flexible endoscope or a laparoscopic member.
  • Jaws 266a and 266b are manipulated between a closed position illustrated in Fig. 25 and a non-illustrated opened position via a tubular actuator member 276 slidably inserted inside tubular forceps frame 270.
  • forceps jaws 266a and 266b are hingedly secured to a distal end of actuator member 276 at respective pivot points 278a and 278b.
  • a foremost staple 280 has a pair of legs 282a and 282b seated in grooves 284a and 284b in respective forceps jaws 266a and 266b.
  • legs 282a and 282b are provided with respective hook-shaped locking elements 286a and 286b.
  • Legs 282a and 282b are connected to one another by a bight portion 288 of staple 280.
  • Bight portion 288 is deformed, in the closed prefiring configuration of staple 280 illustrated in the drawing, so that locking elements 286a and 286b are stag ⁇ gered with respect to their locking position, whereby the staple can be opened upon an opening of jaws 266a and 266b.
  • Leg 282a of staple 280 is formed at a distal end with an inwardly turned finger or tooth 289 provided with a recess 290 for receiving a knob or ball 292 of a more distally located staple.
  • knob or ball 292 may be replaced by a simply rounded proximal end portion 294.
  • the recess 290 acts together with knob 292 or rounded end portion 294 to form a universal ball-and-socket-type joint to facilitate a staple advance or loading operation particularly when a flexible endoscopic mem ⁇ ber is being used in a stapling operation.
  • a staple cartridge or holder 296 is slidably disposed inside a chamber 298 formed at the distal end of actuator member 276.
  • Cartridge 296 holds a plurality of staples 300 identical to staple 280 in a linear array or magazine wherein the staples 300 are disposed end to end in a common closed prefiring con ⁇ figuration as discussed hereinabove with reference to staple 280 and other staples in accordance with the invention.
  • staples 300 are pushed in a distal direction towards forceps jaws 266a and 266b by a heli ⁇ cal compression spring 302 acting via a piston member 304.
  • Piston member is formed on a distal side with a recess 306 for receiving knob 292 of a most proximal staple in the magazine of staples 300.
  • Cartridge 296 in turn is pushed in the distal direction by another helical spring 308 which is compressed between a proximal end of cartridge 296 and a transverse sur- face 310 in part defining chamber 298.
  • spring 308 holds cartidge 296 against wings or extensions 312a and 312b at the proximal ends of forceps jaws 266a and 266b.
  • tubular frame 270 and actuator member 276 are moved distally via operation of respective actuators 314 and 316.
  • Actuators 314 and 316 may be hydraulic circuits or manual actuators or may take any other form known in the art for operating a forceps at the distal end of an endoscopic surgical instrument.
  • Tubular frame 270 and actuator member are preferably moved on tandem so that forceps jaws 266a and 266b remain temporarily in the closed configuration.
  • actuators 314 and 316 are operated so that for ⁇ ceps frame 270 remains fixed while actuator member 276 is shifted in the proximal direction, whereby jaws 266a and 266b are pivoted about pins 268a and 268b and staple 280 is con- comitantly opened.
  • opening the jaws, wings or exten ⁇ sions 312a and 312b rotate inwardly towards one another, thereby pinching the first or most distal staple 300' in the magazine of staples 300 and preventing the entire staple maga ⁇ zine from moving.
  • Wings or extensions 312a and 312b could be alternatively configured to engage the first magazine staple 300' at a distal end of the staple, thereby blocking the dis ⁇ tal advance of that staple and the other staples 300 in the magazine in cartridge 296.
  • actuators 314 and 316 are then operated to shift the opened jaws and the staple further in the distal direction to engage the internal body tissues which are to be closed.
  • actuators 314 and 316 are operated to move actuator member 276 distally relative to for ⁇ ceps frame 270, thereby closing jaws 266a and 266b and staple 280 in opposition to the internal spring bias of the staple.
  • closing the staple brings locking elements into a locking engagement with one another to maintain staple 280 in a closed configuration.
  • jaws 266a and 266b are again opened through a suitable operation of actuators 314 and 316.
  • the opening of jaws 266a and 266b pinches staple 300' and prevents it from moving forward under the force of spring 302 until the jaws have been closed again.
  • the endoscopic instrument 274 is ready for the application of another staple to the internal body tissues of the patient.
  • Figs. 28A, 2bB, 29A, 29B, 30A, 30B, 31A, 31B, 32A- 32C, 33A-33c, 34A-34C and 35 all illustrate further embodi ⁇ ments of a surgical staple in accordance with the present invention wherein (a) the legs of the staple are provided with locking elements which cooperate with one another to maintain the staple in a closed postfiring configuration, (b) at least one of the legs and the bight protion of the staple is pro ⁇ vided with a spring bias tending to force the legs apart to open the staple, and (c) the staple is disposed in a closed prefiring configuration wherein at least one of the legs, the bight portion, and the two locking elements is deformed to prevent cooperation of the locking elements, whereby the staple may be opened from the closed prefiring configuration.
  • a staple or clip 318 has a pair of legs 320a and 320b joined by a bight or bridging portion 322.
  • Leg 320a is provided on an inside surface, i.e., a surface facing leg 320b, with a first locking element 324 in the form of a cylinder 326 attached to the end of a web 328.
  • Leg 320b is provided on an inwardly facing surface with a female locking element 330 including a cylindrical bore 332 communicating with a slot 334 for insertion of cylinder 326, as shown in Fig. 28B.
  • a female locking element 330 including a cylindrical bore 332 communicating with a slot 334 for insertion of cylinder 326, as shown in Fig. 28B.
  • web 328 of locking element 324 is bent in the distal direction in a closed prefiring configuation of staple or clip 318.
  • Web 328 is resilient and assumes a substantially orthogonal configura ⁇ tion upon an opening of staple 318, thereby facilitating the insertion of cylinder 326 through slot 334 into bore 332.
  • Locking element 330 may be formed laterally of slot 334 with beveled or inclined surfaces 336 for guiding cylinder 326 towards slot 334 during a staple closing operation.
  • the staple or clip 338 of Figs. 29A and 29B is pro ⁇ vided on inwardly facing surfaces of legs 340a and 340b with a first locking element 342 in the form of a cylinder 344 at the end of a resilient arm 346 and a second locking element 348 in the form of an angle provided with a slot 350 for receiving arm 346 in a closed postfiring configuration of the staple shown in Fig. 29B.
  • arm 346 of locking element 342 is bent in the distal direction in a closed prefiring configuation of staple or clip 338.
  • the staple or clip 352 of Figs. 30A and 3OB is pro ⁇ vided on inwardly facing surfaces of legs 354a and 354b with a first locking element 356 in the form of a moderately resilient arrowhead 358 at the end of a resilient arm 360 and a second locking element 362 in the form of a pair of angles 364 and 366 which define a slot 368 for receiving arm 360 in a closed postfiring configuration of the staple shown in Fig. 30B.
  • arm 360 of locking element 356 is bent in the distal direction in a closed prefiring con ⁇ figuation of staple or clip 352.
  • arrowhead 358 deforms to enable it to pass through slot 368 and latch onto angles 364 and 366.
  • another staple or clip 370 has a pair of legs 372a and 372b joined by a bight or bridging portion 374.
  • Leg 372a is provided on an inside sur ⁇ face with a first locking element 376 in the form of a cylinder 378 attached to the end of an arm 380.
  • Leg 372b is provided on an inwardly facing surface with a locking element 382 including an angle formed on a distal side with a slot 384 for receiving arm 380 during an insertion of cylinder 378, as shown in Fig. 3IB.
  • arm 380 of locking element 376 is bent in the distal direction in a closed prefiring configuation of staple or clip 370.
  • Arm 380 is resilient and assumes a substantially orthogonal configura ⁇ tion upon an opening of staple 370, thereby facilitating the insertion of a free end of arm 380 through slot 384.
  • Figs. 32A, 32B and 32C illustrate a closed prefiring configuration, a first closed postfiring configuration and a second closed postfiring configuration, respectively, of another staple or clip 386.
  • Staple 396 has two legs 388a and 388b joined to one another by a bight or connecting portion 390.
  • Connected to leg 388a is a first locking element 392 including resilient arm 394 formed at a free end with a hook or flange 396.
  • Fig. 32A arm 394 is bent so that hook 396 is spaced from a second locking element 398.
  • Locking element 398 is provided with a plurality of notches 400 for alternatively receiving hook 396 to lock the staple 386 with different amounts of tension or closure.
  • Fig. 32C shows a staple closed configuration exhibiting a greater tension or degree of closure than the closed configuration of Fig. 32B.
  • a staple 402 illustrated in closed prefiring, opened and closed postfiring configurations in Figs. 33A, 33B and 33C, respectively is essentially identical to staple 352 of Figs. 30A and 3OB except that staple 402 is additionally pro ⁇ vided with a flexible web 404 extending from one leg 354a to the other leg 354b distally of locking elements 356 and 362.
  • Web 404 serves to shield locking elements 356 and 362 from an invasion or interference of internal tissues during a stapling operation (see Fig. 35). Except for web 404, all the struc ⁇ tures of staple 402 are labeled with the same reference numerals as the corresponding parts of staple 362.
  • Figs. 34A, 34B and 34C illustrate closed prefiring, opened and closed postfiring configurations of a staple 406 substantially the same as staple 280 or 300' and staples 300 of Figs. 25 and 26.
  • staple 406 is supplementarily provided with a flexible web 408 extending from one leg 410a to the other leg 410b distally of hook shaped locking elements 412 and 414.
  • Web 408 serves to shield locking elements 412 and 414 from an invasion or inter ⁇ ference of internal tissues 416 during a stapling operation, as illustrated in Fig. 35.
  • any of the staples dis ⁇ closed herein which have locking elements at a proximal or bight end of the staple may be provided with a protective web like web 404 and 408 for preventing the internal body tissues of the patient from interfering with the cooperation of lock ⁇ ing elements on the staples during a staple closure operation.
  • any of the staples or clips of Figs. 28A, 2bB, 29A, 29B, 30A, 30B, 31A, 31B, 32A-32C, 33A- 33c, 34A-34C and 35 may be used in an endoscopic or laparo ⁇ scopic stapling device in accordance with the present inven ⁇ tion.
  • Staples or clips 318, 338, 352, 370, 386 may be formed, like staples 280 and 300 of Figs.
  • FIG. 36A-36C Another staple 418 utilizable in an endoscopic or laparoscopic stapling device in accordance with the present invention is illustrated in Figs. 36A-36C.
  • staple 418 has an internal spring bias which tends to close the staple.
  • Staple 418 is provided with an auxiliary spring element 420 extending between legs 422a and 422b.
  • Spring element 420 has a spring bias which tends to open the staple in opposition to the internal spring bias of the staple itself, the spring force exerted by element 420 being greater than the spring force exerted by the internal spring bias of staple 418.
  • Staple 418 is further provided on a bight portion 424 with a distally extending fracture member 426 of limited flexibility.
  • fracture member 426 In a closed prefiring configuration of staple 418, shown in Fig. 36A, fracture member 426 is held in a deformed state by a projection 428 extending from a proximal side of spring element 420.
  • projec ⁇ tion 428 Upon an opening of staple 418 by an opening of forceps jaws, as described hereinabove, projec ⁇ tion 428 is retracted from fracture member 426 owing to an extension and straightening of spring element 420. Fracture member 426 consequently assumes a straightened configuration, shown in Figs. 36B and 36C.
  • fracture member 426 breaks or ruptures spring element 420, as shown in Fig. 36C, thereby allowing the internal spring bias of staple 418 to close the staple about internal body tissues of a patient.
  • spring element 420 is advantageously provided with a score line (not shown) in the region of projection 428 and fracture member 426, to facilitate the rupture of the spring element.
  • a staple 430 is provided with an auxiliary spring element 432 which is attached to one leg 434a of the staple, but is dis ⁇ connected from the other leg element 434b.
  • a pressure element 436 of limited flexibility straightens from a bent prefiring configuration in which the pressure element is maintained by a projection 438 on a proximal side of spring element 432.
  • the straightened pressure element 436 pushes spring element 432 out of contact with leg 434b, whereby an internal spring bias of staple 430 closes and locks the staple.
  • Staples 418 and 430 are similar to other staples described hereinabove in that staples 418 and 430 are opened by a spring bias. Staples 418 and 430 differ from those other staples in that staples 418 and 430 are held closed by a spring bias rather than by cooperating locking elements.
  • another surgical staple 440 comprises a pair of legs 442a and 442b connected to one another by a bight portion 444.
  • a spring element 446 is con ⁇ nected to the staple 440 at bight portion 444 for providing a spring bias tending to close staple 440.
  • Legs 442a and 442b are provided on their outer sides with outwardly extending rings or loops 448a, 450a and 448b, 450b which are used to pull the staple legs apart, as described below.
  • a forceps for applying staple 440 to internal body tissues in an endoscopic or laparoscopic surgical procedure comprises a pair of jaws 452a and 452b pivotably linked to an elongate tubular frame member (not shown) via respective linking pins 454a and 454b. Alternate opening and closing of jaws 452a and 452b are con- trolled by actuator elements 456a and 456b. Jaws 452a and 452b are provided on their inwardly facing sides with respec ⁇ tive grooves 458a and 458b for receiving legs 442a and 442b of staple 440.
  • each jaw 452a and 452b is provided with a pair of transversely oriented recesses 460a, 462a and 460b, 462b for receiving rings 448a, 450a and 448b, 450b, respectivel .
  • a pair of locking rods 464a and 464b are shifted in the distal direction through longitudinally extending bores 466a and 466b in jaws 452a and 452b.
  • Rods 464a and 46b also pass through rings 448a, 450a and 448b, 450b, as illustrated in Fig. 40, thereby fastening staple legs 442a and 442b to jaws 452a and 452b.
  • the staple may be forced into an opened configuration by a relative proximal motion of actuator elements 456a and 456b which pivots jaws 452a and 452b.
  • actuator elements 456a and 456b which pivots jaws 452a and 452b.
  • locking rods 464a and 464b are retracted and jaws 4452a and 452b are opened, enabling a separation of the forceps jaws from the staple.
  • another staple 468 which functions according to the same principle as staple 440 of Fig. 38 includes a pair of legs 470a and 470b provided with respective longitudinally extending holes 472a and 472b which are traversed by respective locking rods (not shown) similar to rods 464a and 464b of Figs. 39 and 40.
  • Staple 468 is also provided with an internal spring bias or an auxiliary spring element 474 tending to force the staple into the closed con ⁇ figuration shown in the drawing.

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Abstract

Instrument chirurgical comprenant une pince (34) de forme allongée présentant un diamètre suffisamment petit pour être glissée à l'intérieur d'un conduit à biopsie (24) s'étendant longitudinalement dans un endoscope tubulaire (26), la pince étant munie à une extrémité distale d'une paire de mors (34a, 34b), chaque mors présentant sur sa face interne une gorge longitudinale (36). Une agrafe formant ressort et restant de ce fait en position ouverte est placée en position fermée de préagrafage entre les mors et est munie d'une paire de branches (32a, 32b) dont chacune est placée dans une position fermée de préagrafage dans une des gorges des mors. Grâce aux éléments de verrouillage qu'elle présente, l'agrafe peut être verrouillée en position fermée de post agrafage.
PCT/US1992/003589 1991-05-03 1992-04-30 Dispositif et methode d'agrafage endoscopique WO1992019144A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US695,702 1984-10-05
US07/695,702 US5156609A (en) 1989-12-26 1991-05-03 Endoscopic stapling device and method

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WO1992019144A2 true WO1992019144A2 (fr) 1992-11-12
WO1992019144A3 WO1992019144A3 (fr) 1993-02-04

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US5156609A (en) 1992-10-20
WO1992019144A3 (fr) 1993-02-04
AU1925492A (en) 1992-12-21

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